MHA598 Capstone
CASE 4
Trident University
April 2022
Samantha Daniel
Dr. Syntheia Sewell
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Table of Contents
Organization/Facility Development
Health Care Organization/Facility
Data Gathering & Examination
Organizational Dynamics and Structure
Recommendations and Conclusion
Health Care Delivery, Information Systems, & Quality Assurance
Health Care Delivery and Models
Information Systems
Quality Assurance
Recommendations and Conclusion
Regulatory Compliance, Health Care Law, and Ethics
Regulatory Compliance and Health Care Law
Health Care Ethics
Recommendations and Conclusion
Financial Management
Community Benefit Spending
Balance Sheet
Statement of Operations
Strategic Planning, Operational Planning, & Budgeting
Recommendations and Conclusion
References
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Nicole Children’s Medical Center Introduction
Nicole Children’s Medical Center (NCMC) is a nonprofit outpatient facility that provides
services within Fort Worth Texas. Neurofibromatosis (NF) is the focus for type of disease
management. The National Institute of Neurological disorders and Stroke (2022) states that NF
consists of tumors that can involve the areas of “the brain, spinal cord, and the nerves that send
signals between the brain and spinal cord and all other parts of the body” within 1% of the
world’s population. NCMC offer’s services to include ophthalmologic expertise, genetic
expertise and care, lab, and a family of other specialists to include daily involvement with
oncology, cognitive rehabilitation, orthopedics, psychiatry/psychology, ENT, endocrinology,
neurosurgery, plastic surgery, and a speech/hearing program. The target patient adolescent group
is 0-17 years of age. There are several outlying conditions that can occur due to NF. NCMC
provides high excellence, technical advances, and family centered care.
The Mission
NCMC has a mission to inspire hope by implementing outpatient screening processes for
the early onset of Neurofibromatosis by providing not only the best care, but the most integrated
clinical practice available. One percent of all children are diagnosed with JMML leukemia.
According to the Handbook of Clinical Neurology (2015), the prevalence is “1 in 3,500 births
diagnosed with NF1 and 1 in 33,000 births for NF2” each year. NCMC is only one in a handful
of hospitals across the world that treats NF. NCMC commits to providing excellent patient care
through the use of our individualized treatment plans. Each care plan is tailored specifically to
the needs of each individual patient and their family through preventive screening.
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The Vision
The vision for NCMC is: To provide an experience that is unparalleled, so that the
facility may serve as the most trusted within the NF heath care environment. NCMC meets the
need of the community through working groups centered towards NF specific treatment plans.
Our high quality and cost-effective treatment methods ensure that care plans will be highly
effective while meeting unique patient needs. Embodied trusted care enables treatment
opportunities for our patients and that allow them to enjoy the absolute best quality of life.
Geographical/Size Overview
NCMC is a single state and local board system that covers the small geographical area of
Fort Worth Texas. NCMC is also nationally recognized as a nonprofit pediatric hospital that
focuses on community population health. They organization conducts health needs assessments
monthly and performs access to care outreach for populations more prone to NF. The local board
within NCMC has a board of development and education that includes fundraising and
philanthropy to aid in cure research efforts (Murphy, 2015). The downtown location allows for
easily accessible access to care within the surrounding urban communities. NCMC has four
major departments that are considered the core clinical departments. These include neurosurgery,
pediatrics, orthopedics, and ophthalmology. There are 75 employees at NCMC, and each
member is passionate about providing the best care possible.
NCMC Data Examination
City/Geographical Demographics
NCMC was created in a spirit of its vision and has a responsibility to meet the
requirements of the Affordable Care Act. As a not for profit organization, it assess the health
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needs of Fort Worth by evaluating quantitative data for demographics. The Tarrant County
Hospital District identified a need for NCMC’s function as it completed a six-month Community
Health Needs Assessment (CHNA) for 2020 on quantitative and qualitative data within the local
area. Gender and age data aid in understanding the community need for preventative services.
Ages 0-14 represents 21.5% of the total service area, which drives demand for pediatric
preventive services. The overall cancer rate for every 100,000 persons is 437.7, which is less
favorable than the state average of 407.7 (CHNA, 2020), Bersnick, (2017).
Median Population Statistics
The surrounding area of NCMC in Fort Worth according to City-data (2022) online states
there that the total population for 2019 was 909,585. Male presence is “442,453 (48%), the
female population is 467,132 (51%)” and the area has an age range median of 32.8 years. The
household medium income is $65,356. City data (2022) states the racial demographic consists of
a “Hispanic population of 332,505, a black population of 168, 659, and a white population of
346,527.”
Between the years 2014-2018 in Tarrant County of Fort Worth Texas, there were
approximately 42,000 new cases of cancer reported. Proving 13,758 patients that died of cancer
this shows the statistic of every 100,000 people within Tarrant County there were 154 patients
that lost their lives (CDC, 2022). The below survey from U.S. Cancer Statistics Working Group.
The below survey from U.S. Cancer Statistics Data Visualizations Tool (2021), shows data
collected for the need of NCMC in Tarrant County to serve as a preventative cancer treatment
center.
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Catering to the Given Area
Within 2009-2018 it was reported by the Texas Health and Human Services (2022) the
most common medical conditions within the Fort Worth area are adolescent cancer leukemias,
lymphoma, intracranial neoplasm, neuroblastoma, intra-spinal and retinoblastoma, malignant
bone tumors, extra osseous sarcomas, and many other malignant melanomas. There are only 3
medical facilities in Texas that cater to the rare disease NF to include Children’s Medical Center
Dallas, Texas Children’s Hospital, and NCMC. NCMC is the only facility that offers outpatient
chemo therapy visits in order to shrink tumors caused by NF. The psychology department is set
apart from the other two NF facilities due to their specialized cognitive testing that focuses on
motor skills and speech. NCMC is the only facility that offers to teach parents classes on how to
perform their own entry level and basic medical knowledge of home healthcare for their
children.
Nf Tumors may begin as benign but later develop into a malignant and life-threatening
disease. Patients that are treated within the local area for NF will have access to preventative
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services such as neurosurgery referrals, pediatrics, orthopedics, and ophthalmology. Other
departments will be available to help with the expansion treatment to include a genetic
counselor, social worker, a child life specialist, dermatology, plastic surgery, and adolescent
psychiatry. The type and number of existing health care facilities in the area include: 21
facilities in the surrounding Fort Worth area that specialize in various types of melanoma
treatments. NCMC is a facility built with compassion and a foresight just for adolescent trusted
care. This facility stands out from its competitors due to its most current and top of the line early
detection for NF screening process.
Surrounding Cities
The metroplex of the Dallas/Fort Worth area has an additional city that resides between
the two called Arlington. The table below reflects the data collected for each city from city data
(2022). The median household income among the three cities fall within Fort Worth ($65,356).
Arlington has the lowest population of 398,854. The racial demographics between each city are
close with the exception of Dallas having the highest Hispanic population.
Population
Fort Worth
(NCMC)
909,585
Arlington
Dallas
398,854
1,343,573
32
34
33
$65,356
$61,716
$55,332
Hispanic: 36%
White: 38%
Black: 19%
Other: 7%
Hispanic: 30%
White: 36%
Black: 23%
Other: 11%
Hispanic: 41%
White: 29%
Black: 24%
Other: 6%
Age Range Medium
Household Income Medium
Racial
Demographics
Organizational Dynamics and Structure
Organizational Structure
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A board cannot be effective if there is not a clear understanding of their overall
responsibilities, roles, and accountabilities within the organization. NCMC operates through
committees, advisory councils, and task force councils. Flexibility is key component used within
the board structure due to the ever-changing healthcare demands. The functional organizational
structure is a pyramid shaped hierarchy that helps define the functions within NCMC.
Departmentalization encourages autonomy in order to carry out different tasker throughout the
facility. Some of these tasks include… The board of directors control different departments,
which allows for distinct operations monitoring and communication between all departments.
NCMC’s culture is concerned with the dynamic care requirements of NF patients. The
hierarchical structure consists of the board of directors, departmental levels, and the operational
level.
The divisional organizational structure is function-based, whereby the staff is divided
within each department by their level of expertise and tasks needing to be performed. The
functional level includes administrative services, business development, informational service,
and financial services. Together with the medical excellence and healthcare operations
departments, they are the middle level of the organization that reports to the top level of
management to include the CEO and other board of directors. This structure allows for the
separation of duties and ensures all areas stay focused on the mission.
The organizational structure of NCMC focuses on the vision and function of the
organization. The organization gives attention to its core competencies and will outsource
patients to peripheral services if required. This is completed through the department of
administrative services, which saves on costs and fixed expenditures through centralized
operations. Fast communication is the high integration of information sharing within the
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different structural levels. This allows for better resolution through bottlenecks confirming
continuity through all oncology services.
Organizational Leadership and Governance
A facility’s effectiveness is based on its structural and organizational dynamics. It allows
for the coordination of ideas, issues, or changes to flow seamlessly through the organization.
This is so that the overall goal can be achieved within each proper level and channel of the
facility and management team (Anand Narashimhan, n.d). Every level has an expectation of
responsibility for its own component to follow the operation requirement needed to run a
hospital. NCMC’s structure can be compared to a military structured chain of command, and
within its hospital it uses the below organizational chart for their course including departmental
managers, C-level executives, directors, and the governing board of directors.
The leadership management process of NCMC is highly involved in all decisions that
impact the organization’s mission and vision. Correct information is routed up and down the
board, so that health and wellness is emphasized. Their operational structure and governance
align to ensure the end goal is met, but it allows for flexibility enough to adapt to the everchanging healthcare world (Murphy, Peisert, & Murphy, 2015). The group practice manager and
board of directors are in charge of all nonmedical aspects to include scheduling, employee
management, and they act as a liaison for all provider needs. These areas include…
Through the seven elements of governance there are essential parts within the
organization that make up an excellent board. At NCMC the board recruitment focuses on
training and educating within the medical excellence department and ensures their staff are
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current on credentialing and licensure. Its board structure is made up of no more than 5 board of
trustees and several subcommittees to assist with decision processes.
Organizational Leadership and Governance Map
Organizational Theory and Behavior
Institutional Theory explains the complexity that comes from the healthcare organization
(Bloom et al., 1994). The NCMC organization faces new innovations and is constantly
challenged to keep up with an everchanging healthcare environment. To battle these issues,
NCMC ensures that they are equipped with the most up to date equipment and training for their
staff and facility. NF is the focus of treatment within the community, and in order to stand above
all others, they have created a unique cultural competence within the facility. Its care equity
removes barriers that are non-compliant with patients’ needs. NCMC demands inclusion among
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its providers, so that behaviors and social norms of the organization best treat all patients. All
genders, race, and socioeconomic statuses are welcome within the facility. Cultural competence
is what strengthens NCMC, and allows for patient families to really connect with their services.
It can improve the experience and outcome of treatment for patients (Lakshmi, 2019).
A key concern within healthcare is change and instability within processes. NCMC is
obligated to acquire and maintain the expertise needed to take on these professional tasks with
change. Their systemic approach allows them to develop the tools and training to rise above their
competition. This approach allows for strategy adoption, information technology, configurations,
and other conditions that occur within the environment (SHRM 2021). The electronic health
record can expedite labs, radiology, pharmacy, provider information to the patient for education
purposes, and allows easier continuity of care for hospitals outside of NCMC.
Dynamics of NCMC
NCMC target subjects for their market include an adolescent age group ranging from 017 with all races to include Hispanic, black, Asian, and white communities. The Dallas, Fort
Worth, and Arlington metroplex are all areas from where the facility will receive primarily
receive patients, however, this does not exclude patients coming from elsewhere in the world.
Culturally sensitive care is crucial to meet the needs of all patients. Betancourt, Green, and
Carrillo (2002) explain cultural competence is the ability for organizations to effectively deliver
healthcare that meet the social, cultural and linguistic needs of patients.
An example, the ability to unify and bridge certain language barriers can help
accommodate diverse patients, while paying attention to their understanding of the illness and
treatment plan. This can include western medicine along with their own cultural needs. An
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extension of patient centered care includes cultural competence, and it sets the tone for the
provider and the patient. NCMC can assure that their healthcare providers understand the
evolving concept and are able to provide culturally competent care to improve the overall quality
and effectiveness of treatment while reducing disparities (Henderson, Horne, Hills, & Kendall,
2018).
Once a patient enters the facility, they are then greeted by the patient check in center and
triaged for the correct appointment area. The patient work flow of NCMC identifies the priority
of care needed. If a patient needs outpatient care facilities such as pediatrics, orthopedics,
ophthalmology, genetic counselor, mental health, or dermatology they will be sent to their
perspective departments for treatment. Other more invasive services such as neurosurgery or
plastic surgery will require a referral from a NCMC provider to a local hospital nearby.
Mandatory training programs for all employees covering inclusion and respect within the
healthcare environment (to include board members) are mandatory. The training addresses all
areas to include: respect and acceptance, religious accommodations, cultural differences,
generational gaps, and language barriers. The Texas Diversity Counsel offers courses such as the
Diversity First Certification program, toolkit, and consulting to ensure the NCMC team is well
prepared for the dynamics that are faced in this region (txdc.org, 2022).
Recommendations and Conclusion
Healthcare is constantly changing, and NCMC is able to deliver a promise to its patient
population that they will be the top organization with trusted care and new patient treatment
advances for NF patients. It is recommended that NCMC remains involved with new
developments concerning medical treatment advances. The top-of-the-line electronic systems
NCMC can power through delivery of care at an advanced more quality level of care. NF may
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not have a cure now, but with the correct organizational leadership and delivery of care, anything
is possible in the future.
CASE 2: Healthcare Delivery and Models
Accountable Care Organization/Comprehensive Services
NCMC as a non-profit organization will fall under an Accountable Care Organization
(ACO). This children’s facility is driven to help all patients in the preventative care treatment of
NF without profiting from their services (Colla, Lewis, 2016). Because NCMC is an ACO they
do not require their patients to have a PCM. Theycan be seen directly at their facility without a
referral. Providers work as a team, so that they do not unnecessarily repeat tests, and that the best
quality of care is provided to the consumer. Continuity of care is the focus and is in the best
interest of the consumer, so the best possible outcome will be obtained. The overall cost of
medical care can be reduced by avoiding repeat tests or errors in treatment plans. The network at
NCMC includes their oncology providers, cognitive rehabilitation specialist, orthopedic
providers, psychiatrist, ENT, endocrinology, neurosurgeon, plastic surgeon, nurses, and
technician support.
Delivery of Care Map
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Engaging Health
E-health is a strategy used by NCMC to engage patients and allow for continuity of care
to further treatment possibilities. With the rise of Covid-19 and dealing with patients that have
lower immunity, engagement health is imperative in keeping their patients safe. NCMC offers
telehealth by allowing Facetime appointments for those that are not needing labs or any physical
type of care. Facetime telehealth care helps provide better facilitated home care. The patient
portal allows access for consumers to view a provider directory when needing to call or schedule
future appointments (Bauer, 2018). Education materials about NF and other cancers is available
via the patient portal. NCMC allows for online and mobile tools so that consumers can
communicate the dimensions of their immediate issues for follow on care.
Mobile tracking allows for the monitoring of medication side effect treatments and can
allow the physician to make adjustments right away instead of the patient having to wait for the
next available in person appointment. Oncologists can collect the data received from the
telehealth appointments and review information collected in advance of the next appointment, so
no time is wasted. Redundancies are eliminated through the electronic health record (EHR) via
data collection. The overall goal for e-health is to improve patient engagement, outcomes, reduce
emergency rates, can lower cost of care, improve medication management, and patient
satisfaction (Bauer, 2018).
Information Systems
The EHR is used to enable continuity of care and allows for a better treatment plan and
outcome. USA.gov (2019) uses a national survey to identify that 94% of information used within
an EHR is readily available. Evidence shows that 88% of providers prefer the EHR over a hard
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copy record, due to the clinical benefits for their patients, and 75% of providers believe the
delivery of care is expedited. Medhost EHR allows for patient data to be stored electronically in
one folder, allows for an automated prescription process, and can provide education for patients.
The patient’s information will be secured electronically and aids in the delivery of care. This
system allows data to be stored accurately. Medhost allows information to be transferred to
lateral healthcare agencies for smoother transitions of careand allows for the most up to date
economical software, while allowing the required output for the provider (Roboam, 2019).
Medhost also allows for computerized provider order entry (CPOE), patient portal, clinical
decision support system (CDSS), and evolving patient education options (Karimia, 2015).
Standards applied consist of data interchange, terminologies, and knowledge
representation. Medhost has security measures in place that identify errors such as wrong patient
identifiers, incorrect prescription doses, patient information is secured and never lost, and it
allows for the automatic implementation of all Health Insurance Portability and Accountability
Act of 1996 (HIPAA) laws. According to the centers for Disease Control and Prevention (2022),
they state HIPAA is a federally regulated law that stands as a national standard for protecting
sensitive patient information, so that it is not disclosed without consent from the patient. HIPAA
is implemented through the EHR system and ensures the confidentiality of all electronic
information.
The Medhost system does not allow impermissible use and will flag the organization with
these regulations are violated. NCMC regularly tests the backup systems to ensure that
information is stored correctly. Passwords are enforced by each user, and the server is designated
as a secure room with only special entry authorized for staff. Message format standards facilitate
the system in order to exchange patient information within the facility. This allows for
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comprehension within interconnection of data components (Borrks,, Avera, 2010). In case of
system failure there could be a paper medical record developed temporarily until the electronic
systems are back online. Once restored the paper copy would then be transcribed into the EHR.
Operations Management
Organizational Process and their Map’s
Access to care can be a major issue that deals with persistent inefficiencies that are
mainly caused by communication issues. This can quickly turn into healthcare safety and quality
issues when patients continue to reach major gaps in their appointment booking process. Poor
care coordination will lead to a patient’s critical concern not reaching the provider. Information
such as adverse drug interactions, treatment plan issues, or lapses in treatment may require a
patient to be seen in person. The Joint Commission reported from 2014-2015 patient
communication failure was the leading cause of 197 sentinel events (Clarke, Bourn, Skoufalos,
Beck, & Castillo, 2017).
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NCMC is divided into different departments to ensure the mission is completed. The
quality of service relies on the delivery within each department. Each department specializes in
oncology specifically, but allows for different levels of care depending on the needs of the
treatment plan. NCMC ensures that with every phone call missed the patient is contacted within
a 48-hour turnaround time to prevent sentential events from occurring. Once the patient is seen
within the facility, wait times can be an issue with a patient’s satisfaction with their care
experience. NCMC has created a call ahead phone service that allows for patients to check if
there is a long wait time and provide them the option to reschedule. Patients can also login using
their cell phones through a patient portal check in to fill out any paperwork ahead of their
appointment. Below is a map to show the wait time product.
Operational Excellence Scale & Tools
NCMC has significant operational components of excellence that allow a means for the
organization to include work teams, operations and process excellence and performance
management. Performance management is a critical tool used in training and should be
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completed by not only training guides, but through on-the-job training (Mclaughlin & Olson,
2017). Six Sigma training is provided for productivity gains to include revision of policies and
procedures if a current process is hindering the system from seamlessly operating. Failed
processes can lead to revenue loss and detrimental sentinel events, Six Sigma allows for the
recognition of failed processes, and a way to a means of retraining of leadership staff,
employees, and departments. Efficient patient movement in healthcare facilities can significantly
improve the quality-of-care patients receive and substantially improve financial performance
(Mclaughlin & Olson, 2017). NCMC applies the Six Sigma methodology at their facility when
problems arise; the problem defined, validate measurement of the problem, analyze what the root
cause of the problem is, find a solution to improve the problem, and control the problem by
developing a plan. When employees find a process that hinders the workflow, they define the
issue and give thorough examples of how the current failing process is hindering the current
workflow. As a team the employees define the issue, then offer cost effect, safe solutions to the
problem, they measure how the process has improved over a set amount of time. Continuous
process improvement is essential for organizations to meet the challenges of today’s healthcare
environment (Mclaughlin & Olson, 2017). This is best accomplished by a committee comprised
of all levels of staff members, department and facility wide. Teamwork is an important principle
used to maintain superb performance and increase patient satisfaction.
The merging of Six Sigma and Lean can allow the two methods to complement each
other by improving several compliance programs. Lean focuses on eliminating waste and allows
for processes to be streamlined. An example may be to eliminate time used to locate unnecessary
equipment and the use of idle time when items are lost. While Six Sigma brings training value to
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the overall patient care, the Lean process allows for the equipment to be in the area needed to not
waste time, allowing for proper training, and ultimately helps prevent sentinel events.
Quality Assurance and Accreditation
Six Domains of Healthcare Quality
The Agency for Healthcare and Research and Quality (n.d) speak to frameworks for
quality assessment’s that have measures that are developed to create initiatives through private
and public sectors. NCMC follows the six domains of healthcare quality to ensure the best
quantity of care is provided to their patients. Patients are asked several times throughout their
visits for their patient identifiers to ensure they are there for the correct treatment. This helps
provide a safer environment. Providers are not paid per service since NCMC is a nonprofit
facility there is no pressure for unethical or illegal misuse of service.
Organization ethics within NCMC allow for patient centered care in that all staff are
expected to treat their patients with the upmost dignity and respect. Patient centered care is
completed through principles such as a uniform standard of care throughout the facility. In order
to reduce wait times, nurses ensure that patient receive a call or text with wait time information.
Patients are provided the ability to reschedule or utilize telehealth appointments. Appointments
are triaged to ensure those that needing to be seen in person are brought in at their earliest
convenience.
NCMC ensures efficiency by utilizing the most current information systems to secure a
point of service by enabling providers to see all previous medical appointments prior to the
patient’s current visit. This avoids misplacement of documents and boosts productivity. Due to
NCMC’s code of ethics, they do not judge patients on their ethnicity, gender, geographic
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location, or socioeconomic status (AHRQ, n.d). Culturally competent care is provided by a
diversified staff to ensure trust and inclusion are equitable.
Conclusion and Recommendations
Healthcare delivery models for NCMC help build a snapshot of processes that use
improvement within identified areas. This helps the overall organization better utilize their time
for patient care by advancing the best quality of care. Information systems are a part of
continuity of care and allow for a better transfer of patient information. It is recommended that
NCMC attends quarterly training to stay current with compliance standards and continue to
utilize the training to better patient care.
Case 3: Regulatory Compliance, Healthcare Law, & Ethics
Regulatory Compliance & Healthcare Law
Executive Summary-Federal, State, and Local Laws
NCMC ensures that all staff conducts themselves in an ethical manor with an emphasis
on its shared values that will guide all actions they may be questionable within the workplace.
These standards are periodically reviewed then enhancements are created when deemed
necessary by the board of directors. These standards are introduced during orientation for all
employees. Establishing a corporate compliance program within NCMC ensures the safety and
quality of its patients. Proper planning will allow for the organization to manage programs
through government laws and incentives. NCMC utilizes the Patient Safety Quality Improvement
rule and the Patient Safety Act in order to follow government guidelines. Patient Safety and
Quality Improvement rule allows for the organization to improve services and reduce high risk
safety issues. NCMC will collect confidential information from patients about their appointment
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experience and their safety within the visit. The patient safety rule allows for patient safety
violations to be frequently reported to help manage safety events (Agency for Healthcare
Research and Quality, 2020). NCMC will have an open-door policy for reporting unethical
behavior within the organization. The Texas Medical Privacy Act is a more in-depth state law
that gives more privacy protection then under the Federal Health Insurance Portability and
Accountability Act of 1996 (HIPAA). HIPPA. The state law fills in the gaps that the federal law
does not apply. The Texas law has a broader range of regulations, it does not allow patient
information to be used for marketing, and does not allow the re-identification of information of
which had already been un-identified (ASPE, 2001).
NCMC does not use a patients private health information for its marketing strategy
without containing consent from its patients. The policy in place for marketing is that the patients
will advise the providers of the impact they would want their child’s health information to give.
Providers will not approach the families nor proceed with consent without utilizing proper
consent forms through the administrative office. NCMC opposes any policy pertaining to
injectable drugs outside of their practice. Significant risks can occur when outside drugs are
involved within the treatment of a patients care. The liability poses a risk to the integrity of the
product, labeling, and to the condition of the patient of which the drug may be exposing. The
treatment therapies will never be a “self-service” environment and the policy were developed to
protect the mission and vision of the facility by ensuring the proper delivery of the best and most
trusted care.
Corporate Compliance Program Infrastructure
The designation of the Chief Compliance Officer reports directly to the Chief Executive
Officer and the continuing governing board of directors. This also combines the efforts of the
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managers that control the operation of each program through active participation of the
compliance committee. They are all charged with the role of overseeing the laws and regulations
of the facility to ensure that compliance is properly coordinated.
Education, Training, & Safety
Regular training of all staff members will be implemented to include administrators,
providers, and nurses on how to maintain patient confidentiality. HIPPA training is required
annually and through online refresher courses for members that are required. Regular employee
training will be required within each members duties to maintain their expectation and job
performance. This will be a hassle-free process that can be creative and fun throughout the
facility each month. Proper patient confidentiality should be maintained through all electronic
devices. This includes restriction of mobile devices within patient areas. This is to prevent
accidental or malicious attempts to violate sensitive information with photos or recording
conversations. Policies against personal devices exclude all private lap tops and tablets for
protection of patient information. The amount of patient data stored is now astronomical due to
the influx in population and quality of care. NCMC utilizes biometric patient identification to
maintain patient confidentiality and uphold patient security. This product prevents the
duplication of patient files and has encryption features. This cloud-based system can recognize
patients by using their photo (Sohn, Kim, Park, Lee, Monroe, Malone, Kinsella, Yao, Kunos, Lo,
Shenk, & Machtay, 2020).
Two Way Communication in All levels
Effective communication at NCMC is an essential part of the mission due to the flow of
patient care. These tools can be a great way to explore non-compliance within the facility and
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allow for change. The leaders and staff ensure that they are seen each day by being visible and
approachable not only to staff, but patients as well to adhere directly to any concerns. The
organization encourages open communication with no punitive actions or retaliation for
members coming forward with issues (Womble & Dickinson, 2020). All compliance measures
are briefed during weekly meetings to include a daily safety huddle led by the board of directors
and the team leads of all departments. Patents are given anonymous hot line numbers in order to
provide feedback about their appointments (Lovitky, 1999). Quarterly the staff are given a
survey system to voice their concerns about compliance violations or leadership issues.
Monitoring System to Measure Effectiveness
Internal monitoring and auditing are completed daily within the information system
area of NCMC. An annual work plan is developed to address areas of concern to include
analyzing areas of concern from the previous years audit. This allows for the tracking of
trend, benchmark, and identify and outliers. Areas of risk are traced contracts, billing, coding,
and quality of care (Womble & Dickinson, 2020). Audits are completed proactively to meet
the goals set for NCMC and ensure that the compliance programs are being met.
Enforce Discipline & Corrective Action Plan
Standard violations within NCMC are thoroughly enforced with their well published
disciplinary guidance. Appropriate actions will take place the moment a violation occurs so
that the process can be corrected immediately. Errors are sought out and the individual or area
within the organization is identified. NCMC allows for a “just culture” that balances the need
for honest reporting and a responsibility to hold employees accountable if their behavioral
choices prove to be malicious. This culture requires change from errors reported and the
ability to design a system to overcome all obstacles. Below is an algorithm created for the
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outcome of engineering principles that analyze risks according to Frankel and Leonard (010):
Healthcare Ethics
Code of Ethics
In order to determine appropriate behavior within the staff of NCMC, a code of ethics
has been developed to promote dignity and well-being associated with the hospital. NCMC
leads by example by creating a valuable work environment and ensures that unethical
behavior will have zero tolerance. NCMC board of executives abide by the same codes as all
other employees. They have been charged to follow up on all unethical behavior and
encourage respect and trust within the facility. Trust is what allows for maximum service and
ultimate success. The development of NCMC’s ethics plan ensures autonomy for all patients
and applies to all areas to include autonomy, justice, respect, efficiency, proportionality, and
for goodwill (ACHE, 2020). Healthcare ethics provide better avenues when making decisions
for treatment plans and prescribing medications. Autonomy enables a patient to keep their
honor by allowing the patient or guardian to choose for their family how they would like to
proceed with a treatment plan (ACHE, 2020). Beneficence ensures the correct treatment is
provided through a checks and balances system. For example, before providing further care
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the check in desk asks for full patient demographics and then are asked again by the provider
once they enter the facility. Justice is what allows for fair treatment no matter the race or color
which is why NCMC has a staff with different ethnicities and cultures.
An example of the use of code of ethics is ensuring patient privacy is restricted to a
“need to know” only basis. Unauthorized members should not have access to information if
they are not directly involved in the patients care. The ethical practice has legal implications
that effect HIPPA guidelines (ACHE, 2020). Integrity and honesty in a treatment plan is
important so that the patient’s family can be fully prepared for what they will face throughout
a disease such as NF. This can prevent interruption of care create a strong treatment plan in
the beginning of the process.
Healthcare Ethical Committee-Identify the Members
The members on the healthcare ethical committee for NCMC help resolve difficult
issues that could inherently affect the treatment of patients care. The committee studies the
issue and decide as a team to take action or further discuss options. Confidence is promoted
within the organization due to the combining power of knowledge of the team. Their team
includes physicians, nurses from each area, mental health providers, community
representatives, and administrators.
The chairman is a provider that leads the committee and was chosen by the hospital
through a voter polling system. The provider was chosen has they were the most reliable
person to listen to all sides of the situation without judgement and can contribute to the
medical aspect of the ethical decision. This provider is not actively involved in patient care
thus allowing time to respond to issues. There is an assistant to the chairperson which is a
hospital administrator that helps with the policy and regulations that are ethically required.
26
The committee has a secretary to record minutes for each meeting which ensure the
continuity of care on all of the organization’s ethical issues. A lawyer will be present to
determine the federal and state law regulations that can be violated through HIPPA and avoid
penalties from the government. A pediatric oncology specialist will be apart of the decision
process on treatment plans and ethical behavior.
Distinguished Roles & Responsibilities
The role of an ethical committee is to create solutions to ethical treatment decisions
before a mistake is made. They are also involved when mistakes are made and can be an
advisor to staff to maintain the quality of service (Schonfeld & Hester, 2012). The committee
serves as an investigation process to ensure the staff maintain efficient access to all services in
order to make prominent decision-making diagnosis. Stakeholders are not required to take the
advice of a committee board, but there is a requirement of reasoning on why the advice would
be denied. NCMC has an ethical set of bylaws that define the structure of the team.
The committee is multidisciplinary in that the professionals serving have a variety of
expertise. They are charged to be objective in the outcome of the action and be within the best
interest of the patient. The administrator can offer legitimacy and encourage better use of
resources. All members believe in the importance for the committee and devote much of their
time to solving issues (Sconfeld & Hester, 2012). All perspectives on the team are well
respected amongst each other which ultimately creates a professional environment to talk
about all ethical issues.
Conclusions and Recommendations
The healthcare ethical committee is a key factor within LCMC that allows for better
decision-making processes within complex treatment cases. This team is adapted within the
27
structure to benefit the mission and size of the facility. Tracking will promote a clearer picture
of policies and guidelines that are needed for appropriate care. Recommendations include
ensuring the ethical committee team is revied annually in case changes of members are
needed. All staff should be informed of a zero-tolerance policy on unethical behavior.
Case 4: Financial Management
This report will demonstrate how the Nicole Children’s Medical Center will handle its
finances in helping the community. It will also illustrate the organization's spending by using a
balance sheet for the current and subsequent year, with a statement of operation for this
organization. Strategic planning, budgeting, and operational planning are an important part of an
organization because it helps identify suitable operations to align with the company's finances
and goals.
Community benefit Spending
NCMC will spend its budget by providing preventative measures and treatment options
for people in the community diagnosed with Neurofibromatosis. The organization will spend
money preparing and providing the best clinical practices for this medical condition affecting
people through this operation. It will also offer a diagnosis platform for every person to help
them identify whether they are suffering from Neurofibromatosis (Chaiyachati & Werner, 2018).
With this platform in place, it will be easy for the community to access free screenings, clinics,
and other self-help programs within NCMC. It will also invest in research about this medical
condition in Texas to identify its prevalence in this area (Fugate, 2018). The research should help
identify where NCMC can start when dealing with the condition. It will also help identify where
more efforts need to be put to prevent further cases of the conditions and how the community can
support the sick to help them get better easily.
28
NCMC will also use the funds to create awareness in Texas about Neurofibromatosis,
helping the large population know about the disease and get a better idea of how they can
manage the condition with medical assistance from the hospital's medical professionals. There
can also be an initiation of healthcare programs that will help the community; for example, the
implementation of health practices the community should consider for their children and
teenagers, and other highly affected people (Fugate, 2018). It should help the community get
excellent medical care even if they cannot handle all the medical expenses required to treat thee
medical condition (Singh et al., 2018). Therefore, the community will not be expected to make
any payments when using healthcare services from this medical facility. They will also be
expected to get all their medical needs. The community should also expect that from NCMC,
they will get quality medical care for the Neurofibromatosis condition at any time and even
during medical emergencies.
Balance Sheet
This balance sheet will show NCMC's financial position this year and next year by
presenting its assets, liabilities, and net assets to see how the organization will use them.
ASSETS
Current Assets
Cash
Temporary investments
Receivables
Inventory
Prepaid expenses
Total Current Assets
Non-current assets
Land, plant, equipment
Accumulated depreciation
Long-term investments
Other non-current assets
Total non-current assets
Total assets
2023
2022
$23,874
3850
125,675
1205
503
$155,107
$42,300
3600
187,300
1058
600
$234,858
22,345
-9820
18,300
1250
18,800
1,773,907
21,050
-8970
16000
1405
19,705
2,545,630
29
LIABILITIES AND NET ASSETS
Current liabilities
Accounts payable
Notes payable
Accrued expenses payable
Deferred revenues
Estimated third-party adjustments
Current portion of long-term debt
Total current liabilities
Non-current liabilities
Total liabilities
NET ASSETS
Unrestricted net assets
Temporary net assets
Permanent net assets
Total net assets
Total liabilities and net assets
$154800
2340
202450
300
12300
2340
17935
10,879
532,940
$180960
2300
154560
400
18600
2280
20392
10500
508,920
623890
477,765
12082
153,590
$1,240,967
846010
370,800
13700
176,000
$2,036,710
The assets are the valuables in the company that NCMC will benefit from for their
personal use in helping the community. Assets include cash, temporary investments, inventories,
and other assets that could benefit the company. Cash, in this case, is the amount of money
NCMC can access, whether from the bank or at hand (Norwicki, 2018). The organization could
put some investments with maturity for some time, for example, one or two years. These funds
are temporary investments and are expected to help the company in the coming future after their
maturity. Inventories include the costs of needs the company's stakeholders will require, for
example, fuel, food, water, drugs, and other supplies necessary for the company to succeed in its
mission in the community (Norwicki, 2018). These supplies are mostly not yet used but have
already been purchased by the organization. Non-current assets are the resources NCMC will
expect to consume over one year yet have a life span of one year. NCMC has long-term
investments, which it will expect to help it in the future of its operations. For example, the
organization could have corporate bonds and government securities that will help it in future
expenses required to help the community, especially when the company's funds are running low.
30
These investments will act as security for NCMC, helping the organization's operations complete
successfully, especially in the coming future.
When it comes to liabilities, NCMC has a financial obligation or debt that can help its
operations. For example, current liabilities will help the organization within its every year.
Estimated third-party adjustments are the amount of money NCMC will need to return to its
investors, especially from any overpayment to the organization (Norwicki, 2018). Long-term
liabilities include the obligations NCMC has, such as debts that have been due for more than one
year. Net assets differ between assets and liabilities, representing the company's financial
interests. Under these assets, it is important to understand the difference between restricted and
unrestricted net assets. Unrestricted net assets are the net assets NCMC has not restricted
externally by donors and grantors. NCMC will restrict their assets that do not have an expiry for
permanently restricted assets. They include the restricted assets for donors and endowment
funds, but in most cases, they operate without the donors’ restrictions or can be both (Norwicki,
2018). The nature of net assets requires NCMC to disclose the number of donor restrictions and
their nature. This balance sheet shows all operations in NCMC and how they will affect the
company. Additionally, they act as securities for the organization, especially when dealing with
donors and bank loans, showing the expected effects on all leases on the sheet.
Therefore, Assets= liabilities + net assets
Statement of Operations
This statement of operations will demonstrate NCMC's net revenues, expenses, and
overpaid net revenues over this year and the subsequent year. It will demonstrate a relationship
with the balance sheet. The permanent accounts in the balance sheet are the accounts carrying the
balances the company will forward to the subsequent year.
31
REVENUE
Gross patient services revenue
Provision for contractual adjustments
Provisions for charity are
Net Patient service revenue
Provision for bad debt allowance
Net patient services revenue fewer provisions for bad
debt
Premium revenue
Other operating revenue
Total operating revenue
EXPENSES
Salaries, wages, and benefits
Supplies, drugs, and purchased services
Depreciation and amortization
Interest
Total operating expenses
OPERATING INCOME
NON-OPERATING INCOME
Investment income
EXCESS OF REVENUE OVER EXPENSES
Unrestricted net assets
Temporary restricted net assets
Permanently restricted assets
CHANGE IN NET ASSETS
Total changes in net assets
2023
2022
$230,980
-33,509
-1234
196,237
-2050
194,187
$200,490
-28905
-1050
170,950
-13800
157,150
2500
2800
199,487
0
2850
160,000
89,786
79,230
2345
1090
172,451
-300
92,300
75,300
2205
1002
170,807
-4320
$800
789
23,409
5065
2050
$750
-4200
28903
5000
4090
30,524
37,993
Net patient services revenue is the money NCMC will generate through their operations,
except the money will collect from patients due to charity care. NCMC will not expect any
patient service revenue because its characteristic of being a non-profit organization does not
expect any cash flow from its patients' services. Another operating revenue NCMC generates the
office space, rental equipment, and sales supplies of all medicines and equipment it needs
(Norwicki, 2018). The operations of NCMC are not taxed by the government, except other
unrelated business expenses like gift shops are taxed, which differentiates the operating and nonoperating revenue of the company.
32
Operating margin= operating income x 100
Total operating revenue
= -4320 x100 = -2.5%
170,807
The companies operating margin is -2.5% because the NCMC is a not-for-profit organization,
meaning that it will incur negative profits. The company is not expected to make any profits
because its main aim is to help the community without expecting any profits. Therefore, NCMC
will expect additional funding to remain in operation.
Strategic Planning, Operational Planning, & Budgeting
Strategic Planning
The first step in strategic planning is validating mission and strategic interpretations.
NCMC uses strategic interpretations to organize purposes through a mission and vision
statement. By assessing its external environment, NCMC can identify the best environment to
conduct its charity operations, especially where more people have special needs. The
environment should also provide a chance for expansion (Norwicki, 2018). NCMC’s internal
environment should provide a better direction for the company. It can better manage its resources
and have better leadership to use all opportunities and strengths for the community's benefit (de
Paula Rodríguez Perera & Peiró, 2012). NCMC has a vision that has helped through its internal
and external operations. It communicates its vision through its operations, and this has
effectively. NCMC needs to establish a strategic thrust to achieve more on its goals and help the
Texas community such that it can relate its goal to its vision and mission. When it comes to
identifying essential success factors, NCMC must learn the strategies that will help it avoid more
debt and loans, but it should still be able to manage the community services and pay for all
33
expenses. NCMC has properly organized and developed primary and core objectives for the
community benefits. When it comes to financial planning, NCMC should work better to ensure
they can manage the funds they get better.
Operational Planning
NCMC should organize meaningful employee participation in all community service
operations to achieve all objectives. Policies are very important, which NCMC has developed.
Such policies include code of ethics and conflict of interest policies. There are procedures
important for NCMC that can help plan all corporate processes and achieve them successfully
(Norwicki, 2018). All procedures must be clear to all managers and supervisors to ensure they
achieve the specific actions from the policies. NCMC's management needs to develop methods
for strategic planning that will help accomplish the procedures. These methods should be specific
and realistic. NCMC needs to develop strict rules at this time to ensure that all employees follow
them strictly.
Budgeting
Budgeting is an important part for the company to focus on by projecting volumes for the
budget years. The budget committee will ensure that all other factors do not influence the budget.
The managers will then convert the volumes to revenues by identifying whether the budget
should be made after the expense budget is completed (Norwicki, 2018). The organization will
then convert volumes into expense requirements by using them to make orders of supplies and
pay all expenses. The last step the company will make is to adjust all revenues according to their
planning processes to see whether they need to reduce or increase the budget.
Conclusions and Recommendations
34
It is important for NCMC managers to carefully look through all company processes and
see how to organize the processes and ensure they match the community's needs. It is also
important for the company to properly manage all resources to prevent overspending and more
debts. It can be concluded that NCMC will spend its money helping the community by providing
treatment options for people in the community suffering from Neurofibromatosis.
35
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Trident University
Samantha Daniel
MHA598 Capstone
March 2022
Dr. Syneatha Sewell
HEALTHCARE DELIVERY & MODELS
Patient Directory
Electronic
Health
Record (EHR)
ENGAGING HEALTH
Mobile Tools for
Better
Communication
Factime
Telehealth
Appontments
Electronic Health
Record
Medhost
Security Measures
Impermissible Use
INFORMATION SYSTEMS
ORGANIZATIONAL PROCESS MAP
ORGANIZATIONAL PROCESS MAP CONTINUED
OPERATIONAL EXCELLENCE
SCALE & TOOLS
SIX DOMAINS OF HEALTHCARE QUALITY
Safe
Effective
PatientCentered
Timely
Efficient
Equitable
•Avoiding harm to patients by proving care in
that is supposed to help
•Services provided are of benefit to the patient
and avoid underuse or misuse of treatment
•Responsive and respectful care that addresses
all the needs of the patient to include their
values and personal preference
•Reducing wait times for appointments by
enabling access to care and avoid harmful
delays to patient care
•Avoid fraud, waste, and abuse to include
equipment, energy, time, and supply
•Quality of care that does not vary due to
personal bias such as with gender, ethnicity,
socioeconomic status, and ethnicity
Quality
Healthcare
CONCLUSION AND RECOMMENDATIONS
PeopleTraining
Data
Software
Hardware
Process
REFERENCES
Agency for Healthcare Research and Quality. (n.d.). Six domains of health care quality. Retrieved from
https://www.ahrq.gov/talkingquality/measures/six-domains.html
Anand Narasimhan, H. H. (n.d.). Organizational design: Inviting the outside in. Retrieved from IMD Corporate
Learning Network: https://www.imd.org/research-knowledge/articles/organizational-design-inviting-theoutside-in/
Bauer, G. (2018). Delivering value-based care with e-health services. ACHE. Retrieved from
https://www.ache.org//media/ache/aboutache/covid/hap/deliveringvaluebasedcarewithehealthservices5.pdf
Bersnick, J., (2017). Which Healthcare Data is Important for Population Health Management? Retrieved from
https://healthitanalytics.com/news/which-healthcare-data-is-important-for-population-health-management
Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2002). Cultural competence in health care: Emerging
frameworks and practical approaches. New York, NY: The Commonwealth Fund.
https://hpi.georgetown.edu/agingsociety/pubhtml/cultural/cultural.html
REFERENCES
Bloom, J. R., Alexander, J. A., Lerman, S., & Norrish, B. (1994). Institutional and environmental influences on
staffing strategies. Dallas, TX: Academy of Management.
Brooks, P., & Avera, H. (2010). Standards and interoperability in healthcare information systems: Current status,
problems, and research issues. In Fifth MWAIS Conference.
City-data.com. (2022). Welcome to City-data. Retrieved from http://www.city-data.com/
Clarke, J., Bourn, S., Skoufalos, A., Beck, E.H., & Castillo, D.J. (2017). An innovative approach to health care
delivery for patients with chronic conditions. Population Health Management, 20(1):23–30.
doi:10.1089/pop.2016.0076. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278805/#__ffn_sectitle
Colla, C. H., & Lewis, V. (2016). Hospitals Participating in Accountable Care Organizations Tend to Be Large and
Urban, Allowing Access to Capital and Data. Improving Health Care Quality.
REFERENCES
Glandon, G. L., Smaltz, D., & Slovensky, D. (2013). Information Systems for Healthcare Management (8 ed.). Americal College
of Healthcare Executives.
Health Network Community Health Needs Assessment. (2020). Tarrant County Hospital District/JPS. Retrieved from
https://safe.menlosecurity.com/doc/docview/viewer/docN67A799D84BBDe00ba0926bd93e08f4b428d998d5f6b4155eab3
efa049fd4771f296f6807147d
Handbook of Clinical Neurology. (2015). Chapter 4 - Neurofibromatosis type 1 and Chapter 5 - Neurofibromatosis type 2.
Retrieved from https://www.sciencedirect.com/science/article/abs/pii/B9780444627025000044
Karimia, F. (2015). Clinical information systems end-user satisfaction: The expectations and needs congruencies effects. Journal
of Biomedical Informatics, 53:342–354. Retrieved from:
http://www.sciencedirect.com/science/article/pii/S1532046414002731
Lakshmi, N., Adetayo, A., (2019) Cultural Competence and Ethnic Diversity in Healthcare. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571328/
REFERENCES
McLaughlin, D. B., & Olson, J. R. (2017). Chapter 15: Holding gains. Healthcare Operations Management.
Chicago:
Health Administration Press.
Murphy, S. P., Peisert, K. C., & Murphy, C. J. (2015). Board organization and structure. The Governance
Institute.
Retrieved from https://nrchealth.com/wp-content/uploads/2017/05/Board-Organization- Structure_AnIntentional-Governance-Guide_Patrick-M....pdf
National Institute of Neurological Disorders and Stroke. (2022). Neurofibromatosis Fact Sheet. Retrieved from
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurofibromatosis-Fact-Sheet
Roboam, A. R., Orlando, S., Marcos, F., & Sanchez, G. M. (2019). Electronic Health Record implementation: A review
of resources and tools. Cureus, 11(9). Retrieved from https://www.cureus.com/articles/21899-electronic-healthrecord-implementation-a-review-of-resources-and-tools
Song, Z. (2014). Accountable Care Organizations in the U.S. Health Care System. J Clin Outcomes Manag. 2014 Aug
1; 21(8): 364–371.
REFERENCES
Texas Department of State Health and Human Services. (2022). Childhood and Adolescent Cancer
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